Establish and maintain positive clinical rapport with patients and their families, working closely with them in the provision of infusion therapy, education related to self care and self administration, and clinical monitoring of patient response to therapy Assess patient appropriateness for infusion therapy, including safety of the home environment, availability of careg

Travel to provide skilled nursing care for infusion patients in their home Teach patients and their care givers to achieve the highest level of independence possible in self care and monitoring of their infusion therapy Assess the patients' condition and response to therapy, taking action as needed to facilitate achievement of treatment goals Collaborate with physicians a

Establish and maintain positive clinical rapport with patients and their families, working closely with them in the provision of infusion therapy, education related to self care and self administration, and clinical monitoring of patient response to therapy Assess patient appropriateness for home infusion therapy, including safety of the home environment, availability of

Greet patients and conduct check in process Collect or verify demographic information, including key demographic fields Load or update insurance information as needed Verify eligibility and flag appointment accordingly Scan insurance card(s) Collect co payments and outstanding balances Post payments received in practice management system and provide system generated recei

Provide exceptional service to all customers Greets patients as they arrive and manages wait time Complete check in and check out tasks to include insurance verification and copy required documents Collects co payments, co insurance, and deductibles and issues receipts Manages cashier box and daily deposits according to company policies Processes walk in patients and visi

Greet customers into the practice and provide instruction and/or direction as necessary both on the phone and in person Schedule and coordinate all patient appointments as directed Maintain an organized and clean work area, free of clutter Prepare all documentation and records with accuracy as directed or necessary for the patient's care Meet or exceed the performance mea

Evaluate and assess each request verifying eligibility and specific product Determine benefit level based on site of service Utilize written criteria to approve, pend or send the case to the medical director for review Send cases for pending process when appropriate Maintain at least 98% accuracy of clinical review case notes in Facets Maintain productivity standards and

Provides leadership to and is accountable for the performance and direction through multiple layers of management and senior level professional staff Work most often impacts a large business unit, or multiple markets/sites You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succe

Communication and Relationships Leadership Adeptness Staff Performance, Retention and Development Manage salary, bonus incentives, and enforce work rules in a manner that rewards excellent performance, and maximizes staff retention while meeting budget requirements Directly lead, supervise, and develop a team of CSM's as well as team of APC's Maintain overall accountabili

By serving as the link between patients and the appropriate health care personnel, the SICC is responsible for ensuring efficient, smooth, and prompt transitions of care Perform Skilled Nursing Facility (SNF) assessments on patients using clinical skills and utilizing CMS criteria upon admission to SNF and periodically through the patient stays Review targets for Length o

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Perform initial and concurrent review of inpatient cases applying evidenced based criteria (InterQual criteria) Discuss cases with facility healthcare professionals to obtain plans of care Collaborate with Optum Enterprise Clinical Services Medical Directors on performing utilization management Participation in discussions with the Clinical Services team to improve the pr

Practices in accordance with the respective state laws and regulations governing the practice of advanced practice nursing or physician assistants Establishes and maintains effective relationships with patients, care givers, and/or their legal representatives, IDT members, PCPs, other collaborating physicians/providers, and facility staff when applicable Performs an initi

Acts as resource to members calling into a customer service setting addressing medical/health questions Own problem through to resolution on behalf of the member in real time or through comprehensive and timely follow up with the member Provide process and status on previously submitted prior authorizations or pre determination requests Effectively refers and enrolls memb

Perform initial and concurrent review of inpatient cases applying evidenced based criteria (i.e. MCG / Interqual criteria) Discuss cases with facility healthcare professionals to obtain plans of care Collaborate with Optum Enterprise Clinical Services Medical Directors on performing utilization management Participation in discussions with the Clinical Services team to imp